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1.
Pediatr Transplant ; 26(7): e14341, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35808949

RESUMO

Malignancies are among the top three causes of patient death in pediatric and adult kidney transplant (KT) recipients. Solid organ transplant (SOT) recipients, including KT individuals, experience more cancer compared with the general population, including human papillomavirus (HPV)-related anogenital and oropharyngeal cancers. This article describes the epidemiology, pathophysiology and natural history of the HPV infection in both the general population and in SOT recipients, as well as its role in the development of HPV-related pre-cancerous lesions and cancers. Emphasis is given to the primary prevention strategy, HPV vaccination in SOT recipients, and its particularities compared with the general population. Secondary prevention strategies in SOT recipients are discussed and compared with the general population, highlighting cervical cancer screening needs within SOT populations. The article emphasizes how these primary and secondary HPV prevention strategies applied during childhood and adolescence by the pediatric transplant professionals, can lower the burden of HPV-related cancers for SOT recipients in subsequent years, during their adult life.


Assuntos
Alphapapillomavirus , Transplante de Órgãos , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Adolescente , Adulto , Criança , Detecção Precoce de Câncer , Feminino , Humanos , Transplante de Órgãos/efeitos adversos , Papillomaviridae , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/prevenção & controle , Transplantados
2.
Cardiol Young ; 31(8): 1263-1268, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33583456

RESUMO

BACKGROUND: Reproductive issues as related to CHD must be discussed in the clinic and at home. Providers can ensure that correct information is imparted to the adolescent and encourage mothers to provide support and guidance to the adolescent. The level to which these conversations occur is unknown. METHODS: A survey distributed to female adolescent/mother dyads assessed self-reported conversations with the healthcare provider and between each other about reproductive health topics. A clinician survey was completed to assess CHD diagnosis, risk of hormonal contraception, and pregnancy risk. RESULTS: Among 91 dyads, 33.0% of adolescents and 42.9% of mothers reported discussing recurrence risk of CHD with the provider. In regard to the cardiac lesion affecting a baby, 30.7% of adolescents and 28.7% of mothers reported discussing this with a provider. Significantly less adolescents and mothers reported discussing the risks of hormonal contraception and pregnancy with a provider. In assessing conversations between adolescents and mothers, only 44.2% of adolescents and 52.3% of mothers reported discussing with each other the safety of using birth control and 46.5% of adolescents and 64.0% of mothers reported discussing the safety of pregnancy. CONCLUSIONS: Adolescents with CHD and their mothers report low rates of reproductive health-related conversations with the healthcare provider, and mothers report low rates of having these conversations with their daughters. These topics should be discussed at each appointment with the cardiologist and must be encouraged to continue at home.


Assuntos
Anticoncepção , Saúde Reprodutiva , Adolescente , Comunicação , Feminino , Humanos , Mães , Gravidez
3.
J Med Virol ; 87(12): 2122-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26112742

RESUMO

Redetection of a type-specific human papillomavirus (HPV) infection may represent reinfection. However, a growing body of literature suggests that reactivation of HPV is common and that episodic detection of a HPV infection may represent reactivation of a persistent virus. A cohort of prospectively followed adolescent women (N = 150), ages 14-17, was observed on average 6.4 years. The authors describe the redetection of 37 HPV types and associated factors of redetection of high-risk (HR) and low-risk (LR) types using Cox proportional hazard models. Of 1,248 HPV type-specific infections, 286 (22.9%) were associated with redetection after apparent clearance. Chlamydia infections (HR = 1.99 [95%CI, 1.15-3.49]) and non-condom use (HR = 1.1 [95%CI, 1.04-1.99]) were associated with increased redetection of HR-HPV infections. Oral contraceptive pills (HR = 2.73 [95%CI, 1.52-4.90]) and number of sexual partners (HR = 1.44 [95%CI, 1.04-1.99]) were associated with increased redetection of LR-HPV infections. Episodic detection of HPV is common for HR- and LR-HPV types. This finding and identified factors or redetection have clinical implications and enhances the understanding of HPV natural history.


Assuntos
Genótipo , Papillomaviridae/classificação , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Adolescente , Infecções por Chlamydia/complicações , Feminino , Humanos , Estudos Longitudinais , Infecções por Papillomavirus/virologia , Estudos Prospectivos , Recidiva , Fatores de Risco , Comportamento Sexual , Ativação Viral
4.
Sex Transm Infect ; 90(1): 64-9, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24031030

RESUMO

OBJECTIVES: Human papillomavirus (HPV) infections are common in adolescent women, while the rare cancerous sequelae of HPV infections do not generally occur until the 4th or 5th decades of life. This prospective study of a cohort of adolescent women was performed to further our knowledge of the natural history of incident and prevalent HPV infections. METHODS: Self-vaginal swabs collected from high-risk, unvaccinated adolescent women in a longitudinal study were analysed for HPV DNA. Sera were collected at enrolment and later tested for HPV antibodies. Statistical analysis was performed to determine the HPV genotype distribution and duration of detection, and to determine rates of seropositivity and seroconversion for HPV types represented in the assays. RESULTS: 146 subjects (mean enrolment age=15.4 years; mean duration of follow-up=5.8 years) had samples adequate for analysis of HPV detection, and 95 of these subjects had paired sera available. The cumulative prevalence for high-risk and low-risk HPV types was 95.9% and 91.1%, respectively. HPV types 6, 11, 16 and 18 (HPV types represented in the quadrivalent vaccine) were found at some point in 40.4%, 6.2%, 48% and 24% of participants, respectively. Serological data confirmed exposure to these vaccine-covered types, as well as to other high-risk HPV types. CONCLUSIONS: In this cohort of adolescent women, high- and low-risk HPV types were frequently detected, and serological data confirmed exposure in most subjects. The high-prevalence HPV types represented in the quadrivalent HPV vaccine further support vaccination of women at an age well before sexual debut.


Assuntos
Alphapapillomavirus/isolamento & purificação , Anticorpos Antivirais/sangue , DNA Viral/isolamento & purificação , Testes de DNA para Papilomavírus Humano/métodos , Infecções por Papillomavirus/sangue , Adolescente , Alphapapillomavirus/genética , Alphapapillomavirus/imunologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/imunologia , Prevalência , Estudos Prospectivos , Estudos Soroepidemiológicos , Comportamento Sexual , Inquéritos e Questionários , Esfregaço Vaginal , Adulto Jovem
5.
J Infect Dis ; 207(6): 1012-5, 2013 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-23242538

RESUMO

BACKGROUND: Genital human papillomavirus (HPV) infection is believed to be primarily sexually transmitted. Few studies have documented the detection of HPV in the vagina before first vaginal intercourse. METHODS: We used a longitudinally followed cohort of adolescent females without prior vaginal intercourse to examine the frequency of detection of vaginal HPV and the association between first reported HPV detection and noncoital sexual behaviors. RESULTS: HPV was detected in 45.5% of subjects (10 of 22) before first vaginal sex. Seven of these 10 subjects reported noncoital behaviors that, in part, might have explained genital transmission. CONCLUSIONS: HPV can be detected in the vagina before first sexual intercourse, highlighting the need for early vaccination.


Assuntos
Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/transmissão , Comportamento Sexual , Vagina/virologia , Adolescente , Estudos de Coortes , Coito , Feminino , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Infecções por Papillomavirus/diagnóstico , Inquéritos e Questionários
6.
J Infect Dis ; 208(9): 1416-21, 2013 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-23911713

RESUMO

BACKGROUND: Persistent infection with oncogenic human papillomavirus (HPV) is associated with an increased risk of cervical malignancy. Redetection of type-specific HPV after a period of nondetection may be caused by reactivation of a low-level persistent infection. Little is known about factors associated with type-specific HPV redetection. METHODS: For a longitudinal cohort of adolescent women with frequent behavioral and sexually transmitted infection (STI) information (every 3 months), Cox proportional hazard models were used to assess the influence of sexual behaviors and STIs on the redetection of oncogenic or high-risk HPV infections. RESULTS: A total of 210 type-specific high-risk HPV detection episode periods were identified in this longitudinal cohort; 71 (33.8%) were characterized by a period of nondetection followed by redetection. Chlamydia trachomatis (hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.44-6.86) was associated with redetection; redetection was >2 times more likely with each additional self-reported sex partner in the past 3 months (HR, 2.26; 95% CI, 1.35-3.78). CONCLUSIONS: This study demonstrates the role of C. trachomatis and number of recent sexual partners in type-specific HPV redetection. Given that persistent oncogenic HPV infections are associated with cancer-related outcomes, understanding the potential role of such factors in the pathogenesis of HPV-related outcomes is important.


Assuntos
Infecções por Chlamydia/complicações , Chlamydia trachomatis , Coinfecção/diagnóstico , Infecções por Papillomavirus/diagnóstico , Adolescente , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Coinfecção/epidemiologia , Coinfecção/microbiologia , Coinfecção/prevenção & controle , Feminino , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/microbiologia , Infecções por Papillomavirus/prevenção & controle , Recidiva , Comportamento Sexual , Parceiros Sexuais
7.
Matern Child Health J ; 17(5): 879-85, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22729660

RESUMO

Despite recommendations in the U.S. for routine HPV vaccination of adolescent girls since 2006, rates of vaccination continue to be low. This study reports vaccination uptake, factors associated with vaccine uptake and reasons for non-vaccination within a national sample of adolescent females during 2010. Using a computer administered survey of a national sample of 501 mothers of daughters 14-17 years old we assessed maternal reports of HPV vaccination as well as socio-demographical factors, maternal HPV exposures and reasons chosen for non-vaccination. Reported HPV vaccination rates were slightly over 50 % (51.1 %), with 38.3 % reporting completion of all 3 doses. Socioeconomic and demographic factors were not associated with vaccination initiation; however, Blacks and Hispanics were less likely to complete vaccination. The most common reasons for non-vaccination were concerns about vaccine safety, danger to daughter, and provider non-recommendation. Relatively poor HPV vaccine initiation and only modest 3-dose completion continues to be a major public health concern that requires continued efforts to address identified predictors and reasons for non-vaccination.


Assuntos
Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/estatística & dados numéricos , Adolescente , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Internet , Mães , Fatores Socioeconômicos , Estados Unidos
8.
Front Pediatr ; 10: 1057454, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36533243

RESUMO

Malignancies are found between the first three reasons of mortality in pediatric and adult kidney transplant recipients, who overall have disproportionately higher rates of cancer compared to the general population, including human papillomavirus (HPV)-related genital, anal and oropharynx region cancers. Therefore, preventing HPV in this patient population is extremely important. HPV-vaccine was demonstrated to prevent HPV infection in individuals with intact immune systems. In addition, recent data reported less precancerous HPV lesions and cervical cancers with use of HPV vaccine. Since HPV is a sexually transmitted virus that is typically acquired shortly after the onset of sexual activity, it is best to administer the HPV vaccine immunization prior to the onset of sexual activity. This article reviews the epidemiology and pathophysiology of the HPV infection, as well as its role in the development of HPV-related pre-cancerous lesions and cancers in both general population and kidney transplant recipients. The focus is on the most effective primary prophylactic strategy, which is the HPV vaccination. The particularities of HPV vaccination strategies in kidney transplant recipients are compared to the general population. In addition, the article analyzes the various causes of suboptimal HPV immunization rates in kidney transplant candidates and recipients and discusses vaccination optimization strategies that can be applied during childhood and adolescence to reduce the burden of HPV-related disease states and cancer among adult kidney transplant recipients.

9.
J Pediatr Adolesc Gynecol ; 35(3): 299-304, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34999230

RESUMO

STUDY OBJECTIVE: This study evaluated self-reported discussions with health care providers (HCPs) among adolescent and young adult (AYA) women with congenital heart disease (CHD). DESIGN: Data were collected through a one-time survey of AYA women. SETTING: Participants were recruited from pediatric cardiology clinics. PARTICIPANTS: AYA women with CHD, ages 14-21 (N = 107) INTERVENTIONS: None MAIN OUTCOME MEASURES: Questionnaires assessed adolescent characteristics and specific HCP discussions regarding transmissibility of a cardiac condition to the infant, risk of pregnancy, and hormonal contraception. Outcome measures were self-reported discussions with HCPs about these reproductive health topics. RESULTS: Mean age was 16.8 years (SD = 2.1). Self-reported reproductive health discussions were infrequent, including discussions on transmissibility of a heart condition to their offspring (37%), risk of pregnancy to their offspring (34%), risks of pregnancy to their health (46%), and risks of hormonal contraception given their heart condition (21%). Reported discussions were most commonly with a cardiologist. CONCLUSIONS: AYA women with CHD reported limited discussions about reproductive health topics important to those with CHD. Lack of appropriate and timely counseling could lead to poor maternal and child health outcomes. Targeted interventions that improve reproductive health discussions between HCPs and AYA women with CHD are needed to close critical information and service gaps.


Assuntos
Cardiopatias Congênitas , Saúde Reprodutiva , Adolescente , Adulto , Criança , Aconselhamento , Feminino , Pessoal de Saúde , Humanos , Gravidez , Autorrelato , Adulto Jovem
10.
J Adolesc Health ; 69(6): 970-975, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34294508

RESUMO

PURPOSE: With improvements in life expectancy, adolescents and young adults (AYAs) with sickle cell disease (SCD) increasingly face sexual and reproductive health (SRH) concerns. As subspecialists often serve as primary care providers for those with chronic disease, this study examines pediatric SCD providers' practices and attitudes related to SRH of AYA women with SCD. METHODS: We developed an adapted survey to identify SCD provider attitudes and practices in addressing menses, sexual activity, contraception, and pregnancy for their female patients. We electronically distributed this survey to the American Society of Pediatric Hematology/Oncology SCD interest group. We used descriptive statistics to analyze results. RESULTS: A total of 78 pediatric SCD providers completed the survey. A majority (95%) rated SRH discussions as moderately important or higher, with 89% agreeing this care should be standardized. Most respondents reported discussing SRH, such as menses (78%), teratogenic medications (61%), and contraception (90%), with their female patients with SCD at least annually. Although most refer AYAs with SCD for birth control (83%), 39% endorsed a preferred method, with 33% of these favoring levonorgestrel intrauterine devices in this population and 40% injectable contraception. Approximately half of respondents (57%) reported that the use of combined hormonal contraceptives was unacceptable despite published guidelines that support potential benefits outweighing theoretical risk in AYAs with SCD. CONCLUSIONS: The range of SRH conversations and contraceptive recommendations for AYAs from pediatric SCD providers is broad. SCD providers and AYAs with SCD would benefit from improved evidence and educational resources related to contraception as well as coordinated SRH counseling.


Assuntos
Anemia Falciforme , Saúde Sexual , Adolescente , Atitude , Criança , Anticoncepção , Feminino , Humanos , Gravidez , Saúde Reprodutiva , Comportamento Sexual , Adulto Jovem
11.
Transplantation ; 105(4): 736-742, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32890137

RESUMO

Survivors of childhood cancer and other immunocompromised children are at high risk for the development of secondary human papillomavirus (HPV)-associated cancers. In this overview, the authors examine the epidemiology of vaccine efficacy, the natural history of HPV infections, and accelerated HPV-associated cancer development in these populations. The authors highlight the opportunities for preventive care and future research directives.


Assuntos
Alphapapillomavirus/patogenicidade , Sobreviventes de Câncer , Hospedeiro Imunocomprometido , Segunda Neoplasia Primária/prevenção & controle , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Fatores Etários , Alphapapillomavirus/imunologia , Interações Hospedeiro-Patógeno , Humanos , Imunogenicidade da Vacina , Segunda Neoplasia Primária/imunologia , Segunda Neoplasia Primária/virologia , Infecções por Papillomavirus/imunologia , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/efeitos adversos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Vacinação , Ativação Viral
12.
J Pediatr Adolesc Gynecol ; 33(6): 686-690, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32827759

RESUMO

STUDY OBJECTIVE: This study describes menstrual dysfunction and treatment among adolescent and young adult (AYA) females with congenital heart disease (CHD). DESIGN: Data collected from a 1-time survey completed by AYA females (and mothers if AYA unable). SETTING: Participants were recruited from pediatric cardiology clinics. PARTICIPANTS: Female AYA with CHD, aged 14-21 years (N = 114). INTERVENTIONS: None. MAIN OUTCOME MEASURES: The questionnaire assessed sexual and reproductive health (SRH) concerns, behaviors, and management. Outcome measures were self-reported menstrual complaints, use of over-the-counter (OTC) pain relief medications for dysmenorrhea, reported visits with a clinician for a menstrual problem, and reported use of hormones for menstrual problems or birth control. RESULTS: Mean age was 17.0 years (SD = 2.2). The majority of participants (83%) reported 1 or more menstrual complaints (67.5% cramping, 42.1% irregular menses, 46.5% heavy periods), and 88% reported any history of taking OTC medications for pain relief. Increased menstrual complaints were not associated with level of cardiac complexity, reported transplantation, or reported use of hormonal contraception. However, 32% of participants reported use of hormonal contraception for menstrual dysfunction. Combined oral contraceptive pills (COCs) were the most common; 2 of these women carried contraindications to estrogen. CONCLUSIONS: A large majority of AYA females with CHD reported menstrual dysfunction. Use of OTC medication for menstrual pain and inappropriate use of estrogen creates concerns that menstrual disorders may be unaddressed or addressed inappropriately. Thus, gynecological needs of adolescents with CHD may need to be specifically targeted by providers who feel comfortable with this population and their complex needs.


Assuntos
Dismenorreia/tratamento farmacológico , Estrogênios/uso terapêutico , Cardiopatias Congênitas/complicações , Distúrbios Menstruais/tratamento farmacológico , Menstruação , Adolescente , Dismenorreia/complicações , Feminino , Humanos , Distúrbios Menstruais/complicações , Medicamentos sem Prescrição/uso terapêutico , Comportamento Sexual , Inquéritos e Questionários , Adulto Jovem
13.
Front Pediatr ; 8: 46, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32154194

RESUMO

Background: Kidney transplant (KT) recipients have higher incidence of malignancies, including Human Papillomavirus (HPV)-associated cancers. Thus, HPV vaccines may have an important role in preventing HPV-related disease in this population; however, immunogenicity and safety data are lacking. Objective: To examine the immunological response and tolerability to HPV vaccination in pediatric KT recipients compared to future KT candidates. Methods: The quadrivalent HPV vaccine was administered to girls and boys age 9-18 recruited from seven centers part of the Pediatric Nephrology Research Consortium. Subjects were recruited for three groups: (1) CKD: chronic kidney disease stages 3, 4, and 5 not on dialysis; (2) Dialysis; (3) KT recipients. The outcome consisted of antibody concentrations against HPV 6, 11, 16, and 18. Geometric mean titers (GMTs) and seroconversion rates were compared. Vaccine tolerability was assessed. Results: Sixty-five participants were recruited: 18 in the CKD, 18 in the dialysis, and 29 into the KT groups. KT patients had significantly lower GMTs after vaccination for all serotypes. The percentages of subjects who reached seroconversion were overall lower for the KT group, reaching statistical significance for HPV 6, 11, and 18. Comparing immunosuppressed subjects (anyone taking immunosuppression medications, whether KT recipient or not) with the non-immunosuppressed participants, the former had significantly lower GMTs for all the HPV serotypes and lower seroconversion rates for HPV 6, 11, and 18. KT females had higher GMTs and seroconversion rates for certain serotypes. There were no adverse events in either group. Conclusions: HPV vaccine was well-tolerated in this population. Pediatric KT recipients had in general lower GMTs and seroconversion rates compared to their peers with CKD or on dialysis. Immunosuppression played a role in the lack of seroconversion. Our results emphasize the importance of advocating for HPV vaccination prior to KT and acknowledge its safety post transplantation. Future studies are needed to investigate the effect of a supplemental dose of HPV vaccine in KT recipients who do not seroconvert and to evaluate the long-term persistence of antibodies post-KT.

14.
Hum Vaccin Immunother ; 15(7-8): 1929-1934, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30252604

RESUMO

As Otolaryngologists we have witnessed a rise in a new disease with human papilloma virus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC). As of 2018, HPV associated OPSCC has surpassed the incidence of HPV associated cervical cancer within the United States. Non-HPV related head and neck cancer is largely a preventable disease through avoidance of various environmental factors, and we have seen a significant decline in cancer rates through anti-tobacco campaigns and other public health efforts. Given the success of HPV vaccination campaigns and reduction in HPV associated cervical and other anogenital cancers, some would argue HPV OPSCC is largely a preventable disease through vaccination as well. The question remains is how do we as otolaryngologist, non-primary care providers yet surgeons for this disease, help to promote public health efforts to reduce HPV related OPSCC. Within this article, we discuss preliminary data that supports HPV vaccination with HPV related OPSCC and the ongoing needs by our profession to help support public efforts in reducing the burden of this HPV related cancer.


Assuntos
Otorrinolaringologistas , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/prevenção & controle , Papel do Médico , Carcinoma de Células Escamosas de Cabeça e Pescoço/prevenção & controle , Vacinação , Feminino , Humanos , Incidência , Masculino , Papillomaviridae , Saúde Pública , Fatores de Risco , Carcinoma de Células Escamosas de Cabeça e Pescoço/virologia , Estados Unidos
15.
Papillomavirus Res ; 5: 75-79, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29355777

RESUMO

PURPOSE: To assess whether HPV 16 originally detected in adolescent women can be redetected in adulthood. METHODS: A convenience sample of 27 adult women with known HPV 16 detection during adolescence was assessed for HPV 16 redetection. A comparison of the long control region (LCR) DNA sequences was performed on some of the original and redetected HPV 16 isolates. RESULTS: Median age at reenrollment was 27.5 years (interquartile range of 26.7-29.6). Reenrollment occurred six years on average after the original HPV 16 detection. Eleven of 27 women had HPV 16 redetected. Some of these HPV 16 infections had apparently cleared during adolescence. LCR sequencing was successful in paired isolates from 6 women; in 5 of 6 cases the redetected HPV 16 isolates were identical to those detected during adolescence, CONCLUSIONS: HPV 16 may be episodically detected in young women, even over long time periods. HPV 16 redetection with identical LCR sequences suggests low-level persistent infection rather than true clearance, although newly acquired infection with an identical HPV 16 isolate cannot be excluded. However, this study suggests that a new HPV 16-positive test in a clinical setting may not indicate a new infection.


Assuntos
Colo do Útero/virologia , Papillomavirus Humano 16/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Ativação Viral , Adolescente , Adulto , Fatores Etários , DNA Viral/genética , Feminino , Papillomavirus Humano 16/fisiologia , Humanos , Fatores de Risco , Análise de Sequência de DNA , Comportamento Sexual , Latência Viral
16.
Glob Pediatr Health ; 4: 2333794X17743405, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29204462

RESUMO

Understanding where adolescents obtain information about human papillomavirus (HPV) vaccines may be helpful in designing public health interventions promoting HPV vaccination. This study assessed the following: (1) exposure to specific sources of information about HPV vaccines, (2) self-reported helpfulness of these sources of information, and (3) whether the specific source of information was associated with knowledge and perceptions about HPV vaccines among adolescent girls. There were 339 adolescent girls (mean age = 16.8 years) recruited into the study. Television advertisements, the Internet, doctors/nurses, and mothers were the most frequently reported sources of vaccine information; more than 90% of participants who received information from these sources reported they were helpful. Adolescents who received information about HPV vaccines from television advertisements, the Internet, clinicians, and mothers had higher knowledge about HPV vaccines and more positive perceptions. Assuring the accuracy of messages from these sources will be essential, given their importance in influencing adolescents' knowledge and perceptions about HPV vaccines.

17.
Arch Pediatr Adolesc Med ; 160(2): 151-6, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16461870

RESUMO

OBJECTIVE: To examine the association of potentially modifiable factors such as condom use, sexual behaviors, and concurrent sexually transmitted infections with duration of genital human papillomavirus (HPV) infections among adolescent women. DESIGN: Longitudinal observational study. SETTING: Study conducted at 3 inner-city clinics in Indianapolis, Ind. PARTICIPANTS: Forty-nine HPV-positive adolescents were tested frequently for HPV infection and provided sexual behavior diaries. Main Exposures Condom use, sexual behaviors, number of partners, and concurrent infections with Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. MAIN OUTCOME MEASURES: Time from onset to clearance of type-specific HPV infections was analyzed with proportional hazard models. Adjusted hazard ratios (AHRs) were used to assess the effects of risk factors on the duration of HPV infection. Because viral clearance is a preferred outcome, a variable with an AHR less than 1 was considered a risk factor (ie, associated with reduced chance of viral clearance and prolonged infection). RESULTS: Prolonged HPV infection was associated with oncogenic HPV types (AHR, 0.58 [95% confidence interval (CI), 0.39-0.84]) less than median level of condom use during an HPV infection (AHR, 0.53 [95% CI, 0.33-0.84]) and coinfection with C trachomatis (AHR, 0.58 [95% CI, 0.31-0.89]) or T vaginalis (AHR, 0.32 [95% CI, 0.16-0.64]). Not having multiple sexual partners during an HPV infection was associated with early HPV clearance (AHR, 5.52 [95% CI, 3.28-9.30]). CONCLUSIONS: These findings support public health messages of reducing the number of sexual partners, promoting routine condom use, and frequent sexually transmitted infection screening that may be beneficial with HPV infections.


Assuntos
Preservativos/estatística & dados numéricos , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Femininos/epidemiologia , Papillomaviridae , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/epidemiologia , Comportamento Sexual , Infecções Sexualmente Transmissíveis/complicações , Infecções Sexualmente Transmissíveis/epidemiologia , Adolescente , Feminino , Humanos , Estudos Longitudinais , Análise Multivariada , Fatores de Tempo
18.
Semin Pediatr Infect Dis ; 16(3): 168-74, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16044390

RESUMO

Human papillomavirus (HPV) is the most common sexually transmitted disease in both men and women. Prevalence rates are the highest for adolescents. Despite the high prevalence rates, sequelae of genital warts, dysplasia, and cancer are rare developments. Knowledge about the natural history, virology, and cancerous transformation has lead to improved viral detection, including the use of HPV DNA detection tests, screening efforts for HPV-related precancerous and cancerous lesions, and clinical interventions and treatments, including both therapeutic and prophylactic vaccinations.


Assuntos
Doenças Urogenitais Femininas/virologia , Doenças Urogenitais Masculinas , Papillomaviridae/crescimento & desenvolvimento , Infecções por Papillomavirus , Infecções Sexualmente Transmissíveis/virologia , Adolescente , Adulto , Feminino , Doenças Urogenitais Femininas/diagnóstico , Doenças Urogenitais Femininas/epidemiologia , Doenças Urogenitais Femininas/prevenção & controle , Humanos , Masculino , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/virologia , Prevalência , Comportamento Sexual , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Vacinas Virais/uso terapêutico
19.
mBio ; 6(2)2015 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-25805726

RESUMO

UNLABELLED: Puberty is an important developmental stage wherein hormonal shifts mediate the physical and physiological changes that lead to menarche, but until now, the bacterial composition of vaginal microbiota during this period has been poorly characterized. We performed a prospective longitudinal study of perimenarcheal girls to gain insight into the timing and sequence of changes that occur in the vaginal and vulvar microbiota during puberty. The study enrolled 31 healthy, premenarcheal girls between the ages of 10 and 12 years and collected vaginal and vulvar swabs quarterly for up to 3 years. Bacterial composition was characterized by Roche 454 pyrosequencing and classification of regions V1 to V3 of 16S rRNA genes. Contrary to expectations, lactic acid bacteria, primarily Lactobacillus spp., were dominant in the microbiota of most girls well before the onset of menarche in the early to middle stages of puberty. Gardnerella vaginalis was detected at appreciable levels in approximately one-third of subjects, a notable finding considering that this organism is commonly associated with bacterial vaginosis in adults. Vulvar microbiota closely resembled vaginal microbiota but often exhibited additional taxa typically associated with skin microbiota. Our findings suggest that the vaginal microbiota of girls begin to resemble those of adults well before the onset of menarche. IMPORTANCE: This study addresses longitudinal changes in vaginal and vulvar microbial communities prior to and immediately following menarche. The research is significant because microbial ecology of the vagina is an integral aspect of health, including resistance to infections. The physiologic changes of puberty and initiation of cyclic menstruation are likely to have profound effects on vaginal microbiota, but almost nothing is known about changes that normally occur during this time. Our understanding has been especially hampered by the lack of thorough characterization of microbial communities using techniques that do not rely on the cultivation of fastidious bacteria, as well as a dearth of studies on girls in the early to middle stages of puberty. This study improves our understanding of the normal development of vaginal microbiota during puberty and onset of menarche and may better inform clinical approaches to vulvovaginal care of adolescent girls.


Assuntos
Bactérias/classificação , Bactérias/genética , Biota , Vagina/microbiologia , Adulto , Criança , Análise por Conglomerados , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Feminino , Voluntários Saudáveis , Humanos , Estudos Longitudinais , Dados de Sequência Molecular , Filogenia , Estudos Prospectivos , RNA Ribossômico 16S/genética , Análise de Sequência de DNA
20.
J Adolesc Health ; 31(3): 256-65, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12225738

RESUMO

PURPOSE: To better understand maternal influence on the timing of first sex for adolescents. METHODS: Using data from the National Longitudinal Study of Adolescent Health, Cox proportional hazard models were used to assess the association between maternal characteristics and the timing of first sex. Matched dyads of mothers and their adolescent children were used. RESULTS: Of the 2,006 adolescents aged 14 and 15 years who reported to be virgins, 95 males (10.8%) and 162 females (15.8%) indicated they had initiated sex within the follow-up period, 1 year later. For males, few variables beyond the controls used in the models were predictive of timing of first sexual intercourse. For females, mother's satisfaction with her relationship with her daughter (hazard ratio =.62), mother's strong disapproval of her daughter having sex (hazard ratio =.56), and frequency of communication with the parents of her daughter's friends were associated with later sexual debut (hazard ratio =.88). CONCLUSION: Based on the variables in the model, mothers' values and beliefs and relationship satisfaction have more influence on daughters than on sons.


Assuntos
Comportamento Materno/psicologia , Relações Mãe-Filho , Comportamento Sexual/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Psiquiatria do Adolescente , Comunicação , Feminino , Seguimentos , Humanos , Masculino , Mães/psicologia , Modelos de Riscos Proporcionais , Fatores Sexuais , Fatores Socioeconômicos , Fatores de Tempo
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